What condition indicates an overdose of lactulose?
Lactulose
Lactulose is a non-absorbable sugar used in the treatment of constipation and hepatic encephalopathy.[1][4] It is used by mouth for constipation and either by mouth or in the rectum for hepatic encephalopathy.[1] It generally begins working after 8–12 hours, but may take up to 2 days to improve constipation.[2][3] Common side effects include abdominal bloating and cramps.[1] A potential exists for electrolyte problems as a result of the diarrhea it produces.[1] No evidence of harm to the baby has been found when used during pregnancy.[1] It is generally regarded as safe during breastfeeding.[5] It is classified as an osmotic laxative.[6] Lactulose was first made in 1929, and has been used medically since the 1950s.[7][8] It is on the World Health Organization's List of Essential Medicines.[9] It is available as a generic and brand-name product.[4] Lactulose is made from the milk sugar lactose, which is composed of two simple sugars, galactose and glucose.[10][1] History[edit]In 1957, Peitele discovered that lactulose is a bifidobacterium proliferation factor.[citation needed] In 1964, Hoffman found that only bifidobacteria, Lactobacillus and Streptococcus could metabolise lactulose into lactic acid and acetic acid.[citation needed] In 1966, Baicier found that lactulose can promote the growth of basophilic gram-positive bacteria lacking urease (e.g. Escherichia coli) and reduce ammonia production.[citation needed] It has been proven that lactulose reduces blood ammonia, and it has been successfully used in the treatment of hepatic encephalopathy.[citation needed] In 1979, Nianmoleyou treated viral hepatitis with lactulose and he found that lactulose has the effect of reducing plasma endotoxin.[citation needed] From 1980 to 1981, Leicier found that the limulus test agglutination reaction of lactulose inhibits endotoxin in vitro, alleviating the liver injury of rats induced by D-amino galactose. He believed that lactulose had anti-endotoxin activity, meaning that and it can be used in the treatment of liver and kidney syndrome.[citation needed] Medical uses[edit]Constipation[edit]Lactulose is used in the treatment of chronic constipation in patients of all ages as a long-term treatment.[11] The dosage of lactulose for chronic idiopathic constipation is adjusted depending on the constipation severity and desired effect, from a mild stool softener to causing diarrhea. Lactulose is contraindicated in case of galactosemia, as most preparations contain the monosaccharide galactose due to its synthesis process.[12][13] Lactulose may be used to counter the constipating effects of opioids, and in the symptomatic treatment of hemorrhoids as a stool softener.[medical citation needed] Lactulose is commonly prescribed for children who develop fear of their bowel movements and are withholders. This is because lactulose, when dosed in the proper amount, causes a bowel movement that is impossible to retain for very long. Lactulose is also used for the elderly because of its gentle and consistent results.[medical citation needed] Hyperammonemia[edit]Lactulose is useful in treating hyperammonemia (high
blood ammonia), which can lead to hepatic encephalopathy. Lactulose helps trap the ammonia (NH3) in the colon and bind to it.[14] It does this by using gut flora to acidify the
colon, transforming the freely diffusible ammonia into ammonium ions (NH+ Small intestine bacterial overgrowth[edit]Lactulose is used as a test of small intestine bacterial overgrowth (SIBO). Recently, the reliability of it for diagnosing SIBO has been seriously questioned.[17][18][19][20] A large amount of it is given with subsequent testing of molecular hydrogen gas in the breath. The test is positive if an increase in exhaled hydrogen occurs before that which would be expected by normal digestion by the normal gut flora in the colon. An earlier result has been hypothesized to indicate digestion occurring within the small intestine. An alternate explanation for differences in results is the variance in small bowel transit time among tested subjects.[20] Pregnancy[edit]No evidence of harm to the baby has been found when used during pregnancy.[1] It is generally regarded as safe during breastfeeding.[5] Side effects[edit]Common side effects of lactulose are abdominal cramping, borborygmus, and flatulence. In normal individuals, overdose is considered uncomfortable, but not life-threatening.[21] Uncommon side effects are nausea and vomiting. In sensitive individuals, such as the elderly or people with reduced kidney function, excess lactulose dosage can result in dehydration and electrolyte disturbances such as low magnesium levels. Ingestion of lactulose does not cause a weight gain because it is not digestible, with no nutritional value. Although lactulose is less likely to cause dental caries than sucrose, as a sugar, a potential for this exists. This should be taken into consideration when taken by people with a high susceptibility to this condition.[citation needed] Mechanism of action[edit]It is a disaccharide formed from one molecule each of the simple sugars (monosaccharides) fructose and galactose. Lactulose is not normally present in raw milk, but is a product of heat processes:[22] the greater the heat, the greater amount of this substance (from 3.5 mg/L in low-temperature pasteurized milk to 744 mg/L in in-container sterilized milk).[23] It is produced commercially by isomerization of lactose.[citation needed] Lactulose is not absorbed in the small intestine nor broken down by human enzymes, thus stays in the digestive bolus through most of its course, causing retention of water through osmosis leading to softer, easier-to-pass stool. It has a secondary laxative effect in the colon, where it is fermented by the gut flora, producing metabolites which have osmotic powers and peristalsis-stimulating effects (such as acetate), but also methane associated with flatulence.[citation needed] Lactulose is metabolized in the colon by
bacterial flora into short-chain fatty acids, including lactic acid and acetic acid. These partially dissociate, acidifying the colonic contents (increasing the H+ concentration in the
gut).[15] This favors the formation of the nonabsorbable NH+ Society and culture[edit]Name[edit]Lactulose is its international nonproprietary name (INN).[27] It is sold under various brand names.[citation needed] Availability[edit]Lactulose is available as a generic medication.[4] It is available without prescription in most countries, but a prescription is required in the United States and Austria.[citation needed] Food additive[edit]In some countries where lactulose may be obtained without a prescription, lactulose is commonly used as a food additive to improve taste and promote intestinal transit.[citation needed] Veterinary use[edit]Lactulose is used in veterinary medicine.[28] References[edit]
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What happens if you take too much lactulose?If you take too much
Taking an extra dose of lactulose is unlikely to harm you. You may get diarrhoea and stomach pain but this should get better within a day or two. If you're worried, talk to your doctor or pharmacist for advice.
What are 3 side effects of lactulose?Side effects of lactulose. Diarrhoea. Drink lots of fluids, such as water or squash, to avoid dehydration. ... . Bloating. Take lactulose between meals instead of before or after them.. Wind (farting and burping) ... . Feeling sick (nausea) ... . Being sick (vomiting) ... . Stomach pain.. Why does lactulose cause hepatic encephalopathy?Lactulose is used in preventing and treating clinical portal-systemic encephalopathy. Its chief mechanism of action is by decreasing the intestinal production and absorption of ammonia. It has also gained popularity as a potential therapeutic agent for the management of subacute clinical encephalopathy.
Can lactulose cause metabolic alkalosis?Laxative abuse in adults (e.g., bisacodyl, sodium picosulfate, saline laxatives, lactulose, and cisapride) results in electrolyte disturbances (mainly hypokalemia), metabolic alkalosis, and renal tubular dysfunction [176].
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